January 7, 2019
Gov. Gavin Newsom proposes healthcare mandate, Medi-Cal expansion to more
immigrants without legal status
<https://www.latimes.com/politics/la-pol-ca-gavin-newsom-healthcare-proposal
-20190107-story.html> LA Times
By MELODY GUTIERREZ
JAN 07, 2019
Gov. Gavin Newsom announced sweeping proposals to tackle the state's
healthcare needs shortly after taking office on Monday, outlining a dramatic
Medi-Cal expansion that would cover young immigrant adults who are in the
U.S. illegally, require that all consumers in the state carry health
insurance and increase subsidies for middle-class families to help those who
need it.
The Day 1 announcement was as much a rebuke to the Trump administration as
it was an attempt by Newsom to make good on his campaign promise to fix a
fragmented healthcare system that leaves many priced out or underinsured.
The governor also signed executive orders to consolidate the state's
prescription drug purchases into a state-run program and to create a new
surgeon general position to look at health disparities before they manifest,
as Newsom put it.
"Every person should have access to quality, affordable healthcare," Newsom
said earlier Monday in his inaugural address. "Far-away judges and
politicians may try to turn back our progress. But we will never waver in
our pursuit of guaranteed healthcare for all Californians."
Newsom campaigned on a universal healthcare platform and has said the issue
would be among his top priorities. His announcement on Monday stopped short
of the single-payer system demanded by activists that would cover all
residents' healthcare costs, but was characterized as the first step down
that path.
The new governor sent a letter to Congress and the White House asking for
changes to federal laws so that the state can have the regulatory freedom to
overhaul California's healthcare system and move toward single payer.
"We are very pleased that this is a governor who has put forward the vision
of universal healthcare and also seeks to make tangible Year 1 steps to
increase access and improve care," said Anthony Wright, executive director
of Health Access California, a consumer advocacy group. "These are key steps
toward universal guaranteed coverage."
Some of the new healthcare proposals will be included in Newsom's state
budget that will be released Thursday and vetted in the coming months by the
Legislature, when the details and costs of the plan will be reviewed.
"These complex proposals require a lot of scrutiny to fully understand the
consequences - both good and bad," said Assemblyman Chad Mayes (R-Yucca
Valley), the vice chairman of the Assembly Health Committee. "We agree on
the goals of reduced costs, increased competition and better quality
healthcare for all Californians. Government has an important role to play in
holding the healthcare industry accountable; however it must be balanced and
not overreach or hinder innovation."
California would be the first state to cover immigrants without legal status
who are younger than 26 through Medi-Cal, the state's health program for
people with low incomes. California already covers undocumented children
until they turn 19, with Newsom's plan increasing the age cut-off to mirror
that of the Affordable Care Act, which allows young adults to stay on a
parent's health insurance plan until turning 26.
"It's the right thing to do," Newsom said in a Facebook Live feed announcing
the proposal. "It's the fiscally conservative thing to do. It's the moral
thing to do . When we talk about universal healthcare, it means everybody.
When everybody pulls together, it means lower costs to each and every one of
you."
A legislative proposal last year pegged the cost of extending Medi-Cal to
undocumented immigrants under 26 at $250 million a year. That cost would
fall solely to California, despite the mix of federal and state money that
typically comprises Medi-Cal funding because the Affordable Care Act
prohibits the use of federal dollars for covering immigrants who are in the
U.S. illegally.
Cynthia Buiza, executive director of the California Immigrant Policy Center,
called the proposal a "historic commitment that takes us one step closer to
upholding the vital principle that no human being should suffer or die from
a treatable condition, no matter what they look like or where they were
born." "All youth deserve reliable access to healthcare, which will allow
them to focus on living happy and productive lives," said Brianna Lierman of
the Local Health Plans of California, a trade association representing
not-for-profit health plans.
Newsom's proposal would also create an individual mandate in California to
thwart predicted drops in the state's health insurance market after the
federal government removed financial penalties for uninsured consumers
beginning this year. The requirement that consumers have health insurance or
face financial penalties propped up the Affordable Care Act, or Obamacare,
and its elimination is expected to drive up premiums.
Without the individual mandate, all consumers will experience rate increases
this year, said officials for Covered California, the state's official
health insurance marketplace. Covered California Executive Director Peter
Lee said Newsom's proposal would bring stability to the market and is a
critical step toward reaching universal healthcare.
"At a time of ongoing uncertainty from Washington, the governor is not only
embracing policies that will lower the cost of coverage for millions in the
individual market, he is also offering increased help to those who are
struggling with rising costs," Lee said in a statement Monday.
Newsom's plan to create a individual mandate for Californians could be a
heavy lift, even in the Democrat-dominated state Legislature, where such a
requirement could require a two-thirds vote.
Representatives for the governor's office said requiring people to carry
health insurance is central to another proposal to increase financial
subsidies for middle-income families. Newsom's budget will propose that the
income cap be raised so that individuals earning up to $72,840 and families
of four earning up to $150,600 could qualify for lower premiums.
"Gov. Newsom is backing up his words with action, helping make healthcare
affordable and available to all Californians," said David Aizuss, president
of the California Medical Association.
While those proposals have to withstand legislative scrutiny, Newsom took
his pen on Monday to an executive order that does not.
Newsom signed an order to create a surgeon general oversight position in the
state and to consolidate pharmaceutical purchases in hopes of lowering drug
costs for the state and consumers. Under the current system, Medi-Cal and
state agencies separately negotiate prescription drug prices. Under the
order, Newsom's office said the state would become the largest single
purchaser of prescription drugs.
The governor's order would allow small businesses or individuals to join the
state-run collective at the same bulk purchasing price points.
Consolidating prescription drug purchasing in the state has been proposed in
the Legislature over the past several years, but has fizzled in part due to
lobbying by powerful drug interests and the complexity of consolidating the
current system.
"We are in essence taking all of these disparate pieces of state government
that are currently negotiating for drug prices and bringing all them
together in a scope and scale that is unlike any other in the United States
of America," Newsom said.
Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service
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